Choice of empirical treatment in patients with wound infection

Abstract

Objective: We aimed to determine the distribution of infectious agents in wound culture specimens, their resistance rates, and to evaluate empirical treatment choices in wound infections. Methods: Wound culture results of adult patients between 2016-2020 were retrospectively investigated. Determination of bacteria and antibiotic sensitivity tests were done using conventional methods and automatized systems. Results: A total of 2576 wound specimens were sent, and significant bacterial growth was detected in 1254 (48.7%). Most frequently isolated agent was Escherichia coli (E.coli) (24.2%), followed by Staphylococcus aureus (S.aureus) (16.8%). The highest rate of resistance in Enterobacterales species was against amoxicillin-clavulanate (AMC), except Proteus mirabilis. Antibiotics that Enterobacterales species were most sensitive were amikacin and carbapenems, while it was trimethoprim – sulfamethoxazole (TMP-SXT) for Acinetobacter baumannii, and amikacin for Pseudomonas aeruginosa. The highest rate of resistance in S.aureus strains was against penicillin, with a methicillin resistance rate of 22.9%, while no resistance was found against vancomycin. Conclusion: Initial treatment in wound infections is empirical, and the range of treatment is narrowed when results of culture and sensitivity tests are obtained. Clindamycin, AMC, TMP – SXT and ciprofloxacin seem to be appropriate for outpatients, while TMP-SXT or vancomycin for gram-positive cocci, and TMP-SXT and amikacin combination for gram – negatives, and carbapenems as a last resort.